Provider Demographics
NPI:1548870405
Name:SULLARD, SASHA DANAE (RN)
Entity type:Individual
Prefix:MRS
First Name:SASHA
Middle Name:DANAE
Last Name:SULLARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 S FIELDCREST ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-3203
Mailing Address - Country:US
Mailing Address - Phone:316-304-9826
Mailing Address - Fax:
Practice Address - Street 1:8200 E THORN DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2709
Practice Address - Country:US
Practice Address - Phone:316-719-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS115734163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator